An Interesting Case of Giant Cell Arteritis and Stroke

• Published in: Journal of primary care specialties (Online) 2023-09, Vol.4 (3), p.139-141
• Main Authors: Chakraborty, Debabrata, Ray, Nirmalya, Choudhary, Aditya, Bhaumik, Sanjay
• Format: Article
• Language: English
• ISSN: 2772-3615; 2772-3623
• DOI: 10.4103/jopcs.jopcs_41_22

A 73-year-old man known case of giant cell arteritis (GCA) stopped taking his regular steroid. Within a few days, he presented to the emergency room with acute-onset dysarthria and left hemiparesis with the National Institutes of Health Stroke Scale (NIHSS) of 8. The computed tomography (CT) of the head was normal. CT angiography revealed free-floating thrombus at the left vertebral and proximal basilar arteries. We administered injection tenecteplase (0.25 mg/kg body weight), and his NIHSS improved to 3. We did not proceed with mechanical thrombectomy in the apprehension of further mobilization of the free-floating thrombus and consideration of the present stroke scale, which was on the lower side. After 3 h, he developed bradycardia and severe hypotension, requiring noradrenaline support. He also had disconjugate eyeballs with altered mental status and increased paresis. We immediately administered injection methylprednisolone (1 g followed by injectable for another 3 days and then oral steroid) after ruling out cardiac etiology. He improved both neurologically and hemodynamically on the same day and was detected to have pontine-medullary and cerebellar infarcts. In our case, high-dose steroids probably acted as the savior as it handled the inflammation secondary to vasculitis. Steroid is known to save vision in GCA, but its role in the altered hemodynamic state is yet to be reported prompting us to bring this case on stage.